DCI in short and shallow dives

[espenskogen]

I wondered if maybe you would be able to shed some light on a decompression issue that has concerned me a bit lately.

I had a DCI incident in July, following a runaway ascent causing me to miss 15 minutes of deco. Fortunately, the incident was not too serious; and although I had symptoms on the boat (Pins and needles, and cramps in my hands); after 20 minutes on o2 and a short helicopter ride to the chamber, I was more or less symptom free.

I still spent 5 1/2 hours in the chamber, and experienced no additional symptoms after that, but was given 6 weeks diving ban from the doc.


Since them, I've had about 25 dives, most of them at a conservative depth, with no deco and slow ascents. After my last two dives, however, I have noticed slight symptoms of dci - Mild joint pain, although this seem to be wearing off slowly. What concerns me about this, was that the dives I did, was to 17 meters for 20 minutes, on 32% nitrox. I was well hydrated, had plenty of rest, did not exercise significantly before or after the dive, and the dive itself was relaxed and slow. Water temperature was 14 degrees Celcius, and in a drysuit - And on this profile, I should be miles within the no-stop limits. There is always the possibility that what I was feeling was not DCI at all, and that I simply hurt some muscles. I did not breathe o2 after this dive, and the pain has not been unbearable.

Is the previous DCI incident likely to increase my pre-disposition for dci?

I would appreciate the doc's view on this.

Kind regards,

Espen Skogen

 

[gt3073b]

I have never tried a drysuit, but I seem to recall reading here or in the DAN magazine (can't remember) that if you didn't inflate your drysuit sufficiently, you could get pinching at the joints that would cause pins and needles in your extremities (like sleeping on your arm). This was also a contributing factor to DCI because of the reduced circulation and the associated reduction in off-gassing.

Do a search for drysuit squeeze. If you suspect DCI, treat it as such! Better safe than sorry.

Bryan.

 

[espenskogen]

I have never tried a drysuit, but I seem to recall reading here or in the DAN magazine (can't remember) that if you didn't inflate your drysuit sufficiently, you could get pinching at the joints that would cause pins and needles in your extremities (like sleeping on your arm). This was also a contributing factor to DCI because of the reduced circulation and the associated reduction in off-gassing.

Do a search for drysuit squeeze. If you suspect DCI, treat it as such! Better safe than sorry.

Bryan.

No, wasn't drysuit squeeze - Trust me - If you have drysuit squeeze, you'll know it.

I have not experienced pins and needles since my dcs incident - And the term pins and needless is not entirely accurate - It felt more like I was having a continous electric shock through legs, arms and chest - In addition to loosing control of the muscles in my arms.

So if I ever have that kind of dcs again, the answer is obvious - Call the helicopter - Get the oxygen, and off we go.

The bit I'm more concerned about is the slight muscle and joint pain i've been having. This would in any case be symptoms of type I DCS, with pain only, and no neurological damage - However, this makes little sense when I look at my dive profile. Considering neural tissue like spinal cord, brain etc has a far shorter saturation time than muscles, tendants and in deed bone, I would have expected that following a short shallow dive; should any DCS occur, it would be neural.

Having researched this extensively over the last few days, I am beginning to come to the conclusion that the pain was most likely not DCS.
Generating decompression profiles with v-planner on max conservatism, it still gives me a bounce dive profile.

So the only question remaining is: Would a DCS hit pre-dispose me for further hits? Do I need to increase my conservatism, or is the previous dcs hit not likely to increase the chances of future incidents?

Espen

 

[gt3073b]

When my wife got hit about 2 years ago (asphyxia due to vomitting, dumped weight belt), the doctor at the chamber said that nobody is really sure why, but once you get hit you are more likely to get hit again. They weren't even sure if that meant that taking a hit means that you were always predisposed to getting hit, or if the first hit makes you more likely to get hit again.

The doc at the chamber basically said once you get hit you should never dive again (yeah, right). If you do dive, dive nitrox on air tables. (She hated computers and called them Bend-O-Matics).

The diving doctor at her 3 month checkup (different doc) cleared her to dive again and said no deco diving and set the computer personal settings to medium or most conservative. He also made the distinction between a deserved and undeserved hit. He had said that she would now always be more likely to take a hit, but that an undeserved hit would indicate a far greater risk for future hits than her deserved one.

Basically, both docs said you WOULD be more likely to get hit again. Go conservative.

 

[kraken]

Interesting, this conflicts with what I heard from DAN and my doc. They told me after my accident July 2004 I was no more at risk compared to before. Mine was probably an unexpected hit.. nothing obviously wrong (but are you really ever completely rested, hydrated.. etc)

I had a type II hit, with paralysis in both legs and one arm... mega serious. I was cleared to start diving after 30 days.. I waited 90 and given a lot of "suggested" maximums/recommended diving styles. I dive at 1/2 the max with my NEW computer. THe old one was very liberal.. do research not all comptuers are the same.

FINALLY and most IMPORTANT...they did tell me if I get bent again it will be harder to treat me and there is a chance I will not resolve 100%. There are some people on this board and others that have been bent twice.. they didn't follow the docs advice and went diving too soon and landed up with more restrictions.

I've done about 40-50 dives post event, both here in California and overseas. There is an amazing amount of life at 30-40'.

 

[Dr Deco]

Hello readers:

Dr D. was away from the office for a while on NASA business. We were discussing decompression on the Moon. Cool!

DCS and ‘The Bends”

When we discuss decompression sickness, it is always necessary to be sure that we are distinguishing “the bends” (joint pain) from neurological DCS. They have different origins [sometimes] and different outcomes.

“The Bends”

This problem is probably the result of a free-gas phase growing slowly in connective tissue. The bubbles that grow come from nuclei. Experimentally, some individuals can generate nuclei easier than others can. If you have had joint-pain DCS one, and were within the tables and not performing strenuous exercise, then you night well be one of these individuals who easily form nuclei. If so, then you are more susceptible to “the bends” than divers never experiencing this are are.

This susceptibility is different from the idea of becoming more sensitive or susceptible after a “hit.” A case of the bends does not now make you a “bubble former.” You always were and simply were unaware of it. I might add that this is my opinion and might not be shared by all specialists in the diving arena. [I believe that I am, however, correct on this point.]

Conservative diving is in order – and no excessive physical activity.

Neurological DCS

This is a different animal. One incident can result in nerve damage [death of individual neurons] and not allow a complete recovery were another incident to occur. It addition, it could indicate that one has predisposing factors. These would be [1] ease of bubble generation, and [2] a PFO or pulmonary shunts.

Dr Deco :doctor:

 

[kraken]

Hmm I would guess getting bent on the moon would be a bad thing.. local chamber is what 250 million miles away.

I have a small-medium PFO (whatever that means), however I had 600+ dives, many very aggressive prior to the event. I believe I have 100% recovery. I. Assumming a conservative profile (i.e. less than 50-60') and attention to hydration, etc... if it was you would you continue to dive or take up something safer like sky diving?

I understand it is difficult to render judgement via the internet.. but it has been difficult to get a clear answer and anything you have as an example would be great.

Finally I have about 50 dives post accident without incident and find myself quite content to dive in the 30-40' range.

 

[Dr Deco]

Hello kracken:

PFO

The PFO that you described is relatively small. However, several things play a role in a PFO and DCS.

• The first is the hemodynamic significance of the PFO. Do bubbles follow a certain path from the legs to the PFO – in you specifically? There is a certain segregation to the blood flow, believe it or not.
• Second, to you breathe or strain in some fashion that acts as a Valsalva maneuver. There are other ways to perform a Valsalva than just holding your breath and blowing.]
• Third, do you generate many bubbles. This is diver-specific [as found by experiment] and can possibly vary from day to day.

Bad News

The down side of this is that you have apparently already experienced a Type II hit. That means that “all of the above” are true with you - - in come circumstances. The same conditions might well produce the same event. Unfortunately, neurological damage is not repaired as easily with successive events.

I would not agree with the idea that this does not indicate a predisposition; the idea suggests that you are not susceptible again.

Always the same advice is given, namely, keep the gas loads small to prevent the creation of embolizing bubbles. Second, do not do any strains what would result in a Valsalva-like maneuver. Additionally, remember that coughing and sneezing are Valsalva-like maneuvers. I would not take up sky diving.

Dr Deco :doctor:

 

[cdiver2]

As at the moment I am going through something similar.

SYMPTOMS

10-28-05
Leave home 3:30am. Fly Tampa-Huston-Honolulu. About one hour before arriving in Honolulu I started sneezing, coughing, sore throat eyes watering, congested with a lot of mucus.
10-29-05
6:27am arrive in Yap and start taking Sudafed and cough drops sleep through night.
10-30-05
Up at 5:30am breakfast and Sudafed.
1st dive 87’ 50 min No problems
2nd dive 58’ 85 min slight problem clearing ears
3rd dive50’ 56 min slight problem clearing ears
Sudafed
Dinner Hamburger and French fries. One bite of the Hamburger and I vomited.
10-31-05
Slight reverse ear, no diving no apatite. Sudafed and cough drops.
11-01-05
Still no appetite or taste. See Dr. Inner ear infection and fluid trapped. Antibiotics and Sudafed.
11-02-05
Antibiotics and Sudafed. Appetite coming back.
11-03-05
Antibiotics no Sudafed
11-04-05
Antibiotics
1st dive 80’ 61 min
2nd dive 77’ 63 min
3rd dive 25’ 56 min night dive
11-05-05
Antibiotics OK
PM flight to Palau. As soon as I got on the plane same symptoms as before but not as bad. Sudafed
11-06-05
1st dive 86’ 56 min.
Lunch (Diarrhea)
2nd dive 90’ 41 min OK
Dinner
11-07-05
Toast & tea for breakfast
1st dive 90’ 45 min OK
Did not take snack not hungry or thirsty.
2nd dive 105’ 50 min
Lunch only had Potato chips and a coke not hungry or thirsty. Urinated, Light head and a stomach ace
3rd dive 119’ 43 min. feel fine

45 min boat ride back to the dock. Light head again and stomach ace.
About half way back we ran into a rain storm, I got wet and very cold, started shaking violently. Started to vomit , about half a egg cup yellow bile and then dry heaves.
Whilst in the standing position I started to have difficulty moving my right leg and it felt like it was swollen. At this point I sat down and lost feeling in my left leg and lay back against the side of the boat totally fatigued.
Arriving back at the dock about ten minuets later I was unable to move at all, arms, legs, head.
I was put into the horizontal position and given O2, after a short time on O2 I started to feel a pins and needles sensation in my legs when touched. I walked of the boat to a stretcher with assistance still on O2. In the emergency I was able to get myself off the stretcher and on to the bed where my BP and pulse was taken and a IV saline solution given, I was taken off the IV after I had about ¼ of the bag, feeling very cold. I was taken off the O2, non of the symptoms returned. Next I was taken to the chamber and stopped to urinated on the way, on entering the chamber I got the dry heaves again.
Chamber 60’ 2 hours 15 minuets with O2 and periodically taken of the O2 for two minuets. Four sips of water whilst in the chamber.
On leaving the chamber I drank two cans of fruit juice and felt OK but weak, walked out of the hospital under my own steam, small amount of soup for dinner. The next day I was back at the chamber for a follow up and the DR was pleased but no more diving on the vacation. Apatite started to return
It was three days later before I did not feel any fatigue at all and was running around the jungle in a rain storm.

Chamber Dr said. "It was not a hit but DEHYDRATION and HEAT EXHAUSTION. The chamber ride was to help me off gas quicker and recover from from this faster."

DAN said "Sounds like a hit. There is no scientific proof that dehydration will cause a bend though"

Family Dr said "Sounds like you got flu and were able to dive whilst using a drug (Sudafed ), No apatite for food or water was caused by the flu. If I did take large quantities of ether I would vomit. Continuing to dive with no intake caused, 1/ dehydration. 2/ heat exhaustion. I then used up all my energy diving. My body then started to use up all the protein in my body. No protein = no muscel, down I went.

I will be seeing another diving Dr next week.

 

[kraken]

PFO

The PFO that you described is relatively small. However, several things play a role in a PFO and DCS.
• The first is the hemodynamic significance of the PFO. Do bubbles follow a certain path from the legs to the PFO – in you specifically? There is a certain segregation to the blood flow, believe it or not.
• = I’m not really sure, is there any way I can tell? I never thought to ask my cardiologist.
• Second, to you breathe or strain in some fashion that acts as a Valsalva maneuver. There are other ways to perform a Valsalva than just holding your breath and blowing.]
• =So here is the story, after my second dive of the day I returned to my room to change batteries before my 3rd dive. While I was in the room my hand started to tingle. I knew at that point I was probably having some level of small bubble trouble. I grabbed a pair of dry shorts/t-shirt and did a valsalva like maneuver. Moments later the paralysis started in my hand and raced up my arm, fell to floor throwing up violently, got up on the bed and screamed for help, felt like someone was sitting on my chest, about then my roommate came in and my legs stopped working and I fell on my back on the bed. I will tell you I have never experienced pain like that. •
• Third, do you generate many bubbles. This is diver-specific [as found by experiment] and can possibly vary from day to day.
• Normally I would guess probably not. The day before I did 4 dives (none deeper than 110’), each resulting in several minutes of deco obligation which I cleared then did my 5 minute stop. I’ve done some pretty aggressive stuff in the past (these were planned and we used o2), i.e. 1hr + deco obligations without any problems other than shrived fingers and toes (heheh). I do remember having some super sharp pains in my stomach between dives, but I figured it was just local food. Of course I would say as soon as I got to 40-50’ it went away. I read some time ago that other people have had that happened prior to being bent bad. Never heard that stomach pains could be a form of DCI, so never considered that before dropping back into the water. By all means, please don't take this as I was being smart by diving so agressively, I realize now if I could be in a lot worse shape other than just a few bad memories and lots of med bills:58

Bad News

The down side of this is that you have apparently already experienced a Type II hit. That means that “all of the above” are true with you - - in come circumstances. The same conditions might well produce the same event. Unfortunately, neurological damage is not repaired as easily with successive events.

I think I was going through a minor type I and then the valsalva resulted in the type II, is that a reasonable assumption?

I would not agree with the idea that this does not indicate a predisposition; the idea suggests that you are not susceptible again.

Always the same advice is given, namely, keep the gas loads small to prevent the creation of embolizing bubbles. Second, do not do any strains what would result in a Valsalva-like maneuver. Additionally, remember that coughing and sneezing are Valsalva-like maneuvers. I would not take up sky diving.


Thanks, I hope someone learns from my mistake